Bariatric Times - January 2009 - (Page 16)

Psychological Perspective Bariatric Times • January 2009 This internalization of the societal weight stigma may have contributed to the individual decision to maintain some degree of “secrecy” or “limited disclosure” among participants in this study. from a patient’s perspective and I just became sold on it (the surgery).” therefore went in (to surgery) alone, without any kind of support.” NOT TELLING Once the decision to have surgery had been made, many of the participants continued to keep their surgical decision secret even as the surgical event approached. “I only told my best friend, my husband, and my children who were sworn to secrecy” and “I didn’t tell people…I went out of town to have the surgery,” were characteristic responses. Participants described going away for their surgeries so they could keep their secret in the following way: “ …It was like this little compound, where you had the surgery. Then you lived in an apartment away from your family and everyone for several weeks.” As the decision to not tell was explored, the issue of being labeled a failure and the stigma related to their inability to lose weight emerged. One woman stated, “I had so much hope going in but fear as well, so I didn’t want to tell too many people. I thought this is going to be one more thing that I fail at as far as my weight goes.” Another participant reported failing to disclose her decision even after the surgery was performed. She said, “I do not wear it on my sleeve that I’ve had it (the surgery) because I think once you do, people scrutinize you and they are waiting for you to fail.” Other commonly voiced reasons for not telling were, “I didn’t want people to scare me” and “I didn’t want to hear that I could die.” Clearly these participants recognized that others would voice reactions to their decision, and made the following comments: “People have strong reactions and I didn’t want to hear it” and “I didn’t want to have to explain or defend myself—I was doing it.” However, limited disclosure or secrecy might also have an unfortunate outcome—a self-imposed limitation in the development of a strong social support mechanism. Participant statements related to this observation were reported as, for example, “I did not tell my parents, sister who is a doctor, or anybody. That limited my support, but I was willing to do that.” One participant stated, “I’ve talked to people whose families were dead set against them having (bariatric) surgery, and they DISCUSSION AND CONCLUSION The emotional burdens that confront obese persons are confounded by a societal stigma related to obesity. Fabricator and Wadden8 report that obesity stigma is a socially acceptable form of prejudice that frequently leads to depression, isolation, and poor self esteem. As a result of this stigma, obese persons report they have experienced discriminatory behaviors in multiple aspects of their personal and professional lives that have negatively affected their attitudes and beliefs in themselves. This internalization of the societal weight stigma may have contributed to the individual decision to maintain some degree of secrecy or limited disclosure among participants in this study. Bariatric surgery requires lifestyle changes, which occur most satisfactorily when the individual reports an environment of support from significant others. The secrecy behavior that emerged from the interviews is one of particular concern to individuals involved in both preand postoperative teaching and counseling of the person who is planning to undergo WLS. What may ultimately be at stake for the person who has chosen to limit disclosure is a weakened support network that may have implications on achieving positive postoperative outcomes. Persons who are never informed by the individual who chooses to undergo WLS cannot logically be expected to serve in a support role. However, an interesting finding from these interviews is that many of the negative comments, either stated or anticipated, were attributed to those closest to the obese individual. One would expect family members and close friends to be supportive and sympathetic, but that was not the lived experience of many of these participants. Instead, many reported feeling further stigmatized by the lack of support from their family and friends. It is unclear and beyond the scope of this research to understand the meaning and origin of hurtful comments. In fact, the remarks may be a desperate attempt on the part of family and friends to protect the participants from yet another failed try at weight loss. Another explanation may be that family members feel a shared responsibility for the participant’s obesity and they do not want the additional responsibility of any possible negative outcome from WLS. The findings of this research, that participants perceived negative responses from others and felt a need to hide their decision to have WLS, are consistent with the findings of stigmatization and discrimination found by Rogge, Greenwald, and Golden.9 From a social construction perspective, obesity is a problem about losing weight, yet when these participants chose a surgical intervention to lose weight, their choice was still perceived as socially unacceptable or “the easy way out.” As a result, individuals felt the need to be secretive in their choice to undergo WLS even while acknowledging that the secrecy limited their access to support systems that are considered critical in achieving postoperative success. The loss of preexisting support systems (family and friends) heightens the importance that healthcare professionals evaluate the preoperative commitment from the individual to attend postperative support group sessions. This intervention may help the person establish trusting social support mechanisms. period and its potential impact on the long-term success of persons who undergo WLS. As the number of persons who undergo bariatric surgery continues to grow, additional research focused on the person’s ability to form or properly utilize support mechanisms and the potential impact on long-term outcomes related to bariatric surgery is warranted. Alternatively, outcomes-related research regarding the formal participation of individuals in postoperative support groups, composed exclusively of other postoperative bariatric patients, would also fill a gap in knowledge. Ultimately, understanding the individual’s relationships with significant others and the availability of adequate support systems is important to all healthcare providers who are caring for these individuals. Otherwise, secrecy and stigma may continue to create barriers in the achievement of success in persons who undergo bariatric surgery. ACKNOWLEDGMENT The authors would like to acknowledge the support of the National Association of Bariatric Nurses (NABN) and the Iota Xi Chapter of Sigma Theta Tau for their financial support for this research. REFERENCES LIMITATIONS AND FUTURE RESEARCH The primary limitation of this research is the lack of diversity among participants; all participants were well educated females. However, this profile, while resulting in a highly homogeneous sample, is typical of the majority profile of WLS population. Areas of future research are needed to investigate the intimate role that interpersonal relationships may have on obese persons and their families, particularly when comparing the experiences of obese persons who choose to undergo WLS versus those who do not. Exploring the meaning and significance of obesity in the individual’s childhood and within the family structure and dynamics, as well as the parent-child/adult relationship, would be enlightening. Perhaps such examination could shed further light on the meaning of secrecy behavior as described in this study. Another area in need of research is the role of family support or lack of support in the postoperative recovery 1. 2. Buchwald H. Bariatric surgery for morbid obesity: Health implications for patients, health professionals, and thirdparty payers. Surg Obes Relat Dis. 2005;1(3):371–381. Collins B, Miyashita T, Schweitzer M, et al. Why Rouxen-Y? A review of experimental data. Arch Surg. 2007; 142(10):1000–1003. Robinson A, McGrail M. Disclosure of CAM use to medical practitioners: A review of qualitative and quantitative studies. Complement Ther Med. 2004;12(2–3):90–98. Keijsers L, Frijns T, Branje SJT, Meeus W. Disentangling adolescent nondisclosure and secrecy: A four-wave longitudinal study. Paper presented at the Society for Research on Adolescence. March 2008, Chicago, IL. iVillage. Do you diet in secret? Available at http://ivillageindex.ivillage.com/ivillage/archives/2008/06/ do-you-diet-in-secret.html. Accessed November 16, 2008. Puhl RM, Moss-Racusin CA, Schwartz MB, Brownell KD. Weight stigmatization and bias reduction: perspectives of overweight and obese adults. Health Educ Res. 2008;23(2):347–358. Van Manen M. Researching lived experience: Human science for an action sensitive pedagogy. London: Althouse; 1990. Fabricatore AN, Wadden TA. Psychological aspects of obesity. Clin Dermatol. 2004;22(4):332–337. Rogge MM, Greenwald M. Golden A. Obesity, stigma and civilized oppression. ANS Adv Nurs Sci. 2004;27(4):301–315. 3. 4. 5. 6. 7. 8. 9. AUTHOR CORRESPONDENCE Douglas Sutton, EdD, ARNP, ANP-C, Assistant Professor, Florida Atlantic University, 777 Glades Road, Boca Raton, Florida 33431; E-mail: dsutton@fau.edu. http://ivillageindex.ivillage.com/ivillage/archives/2008/06/do-you-diet-in-secret.html http://ivillageindex.ivillage.com/ivillage/archives/2008/06/do-you-diet-in-secret.html

Table of Contents Feed for the Digital Edition of Bariatric Times - January 2009

Bariatric Times - January 2009 Surgical Perspective Psychological Perspective Metabolic Perspective Editorial Message Table of Contents Editorial Board Anesthesiology Perspective Body Contouring Perspective Journal Watch Advertiser Index News & Trends

Bariatric Times - January 2009

For optimal viewing of this digital publication, please enable JavaScript and then refresh the page. If you would like to try to load the digital publication without using Flash Player detection, please click here.